With thousands of cancers, thousands of families and thousands of deaths, I came to see deep time. I absorbed the finite nature of existence and gained a long view. Not just yesterday’s tests, today’s battle and tomorrow’s treatment, but the loss to come. I do not know when the reaper will arrive, but understand he will. I mourn each patient before we meet. I have learned not to cry. Call it ...

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If I have to hear, "There is always a third victim in these situations, don't forget to take care of yourself," one more time, I may go crazy. I wish people would be cognizant of the language they use. According to the dictionary, a victim is, "a person who suffers from a destructive or injurious action or agency." Don't call me a victim. I go home afterwards, completely broken by what just ...

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Among surgeons, it’s pretty common knowledge that residents and other providers may perform non-critical parts of a patient’s procedure. This not only helps residents and other trainees gain valuable surgical experience, it also gives patients better and faster access to high-demand surgical expertise. The question is this: How well are surgeons explaining these facts to their patients? Recent guideline updates by the American College of Surgeons (ACS) underscore the need ...

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As physicians ready themselves for the future of medicine under onerous MACRA regulations, it seems appropriate to glance into the future and visualize the medical utopia anticipated by so many.  Value-based care, determined by statistical analysis, is going to replace fee for service. Six months ago, I received my first set of statistics from a state Medicaid plan and was told my ER utilization numbers were on the higher end compared ...

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It would never have gone down this way ten years ago when length of stay was all the buzz. The CT scan would have been done in the emergency department, and the patient would either have been discharged or admitted for a quick observation stay. Bing, bang, boom. One, two, three. Instead, the CT was pushed until morning. A resident saw the patient at midnight and then not a single practitioner ...

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I use an ongoing spreadsheet to keep track of and to report my demographics and stats for each telepsychiatry consult shift I do. I’ve done thousands of consults in over two dozen South Carolina emergency departments over the last half-dozen years. We have now gone over thirty thousand consults as a group. It never ceases to amaze me, as I fire up my computer, log on to my systems and bring ...

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Medicine, what a noble profession.  As the keepers of human health and longevity, we are entrusted with a huge but solemn responsibility.  It’s an ancient artwork, passed through the generations from pre-antiquity, hand in hand from physician to physician.  The Hippocratic oath ensuring that we first “do no harm” and commit ourselves to the honorable calling.  We often hear “see one, teach one, do one” and so propagates the training ...

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Part of a series. Those of you who have read some of my past posts are aware that I wrote mostly about various aspects of primary care and our dysfunctional healthcare delivery system overall. About 18 months ago I wrote a post for KevinMD on moving to a retirement community. More recently I became focused on the primary care needs of older individuals and from there got ...

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Since the study of science is the most common route taken to a career in medicine, there’s a tendency among doctors to neglect, if not outright scoff at the arts and humanities. That’s a shame, and not only because an appreciation of history or philosophy might make you a better doctor. I’m in complete agreement with that notion, but as an opinion, it can’t be definitively proven. Instead, I think it’s ...

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Monday night, at Lincoln Center waiting for Beethoven’s Ninth to begin. Masses of glass spatially dividing David Geffen Hall from the Metropolitan Opera, are still allowing for the majestic Viennese crystal chandeliers next door to provide the necessary visual interruption between the two symphonic masterpieces, Beethoven’s Eight and Ninth. For me, the excitement about this particular event is deeply personal: Ode to Joy became part of my classmates’, my friends’ collective ...

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